定期报告对当地铜绿假单胞菌和不动杆菌属对抗生素的敏感性、抗生素使用及耐药模式的影响。

Influence of regular reporting on local Pseudomonas aeruginosa and Acinetobacter spp. sensitivity to antibiotics on consumption of antibiotics and resistance patterns.

作者信息

Djordjevic Z M, Folic M M, Jankovic S M

机构信息

Department to Control Hospital Infections, Clinical Centre Kragujevac, Kragujevac, Serbia.

Clinical Pharmacology Department, Clinical Centre Kragujevac, Kragujevac, Serbia.

出版信息

J Clin Pharm Ther. 2017 Oct;42(5):585-590. doi: 10.1111/jcpt.12557. Epub 2017 May 27.

DOI:10.1111/jcpt.12557

PMID:28556289

Abstract

WHAT IS KNOWN AND OBJECTIVE

Regular surveillance of antimicrobial resistance is an important component of multifaceted interventions directed at the problem with resistance of bacteria causing healthcare-associated infections (HAIs) in intensive care units (ICUs). Our aim was to analyse antimicrobial consumption and resistance among isolates of Pseudomonas aeruginosa and Acinetobacter spp. causing HAIs, before and after the introduction of mandatory reporting of resistance patterns to prescribers.

METHODS

A retrospective observational study was conducted between January 2011 and December 2015, at an interdisciplinary ICU of the Clinical Centre Kragujevac, Serbia. The intervention consisted of continuous resistance monitoring of all bacterial isolates from ICU patients and biannual reporting of results per isolate to prescribers across the hospital. Both utilization of antibiotics and density of resistant isolates of P. aeruginosa and Acinetobacter spp. were followed within the ICU.

RESULTS AND DISCUSSION

Resistance densities of P. aeruginosa to all tested antimicrobials were lower in 2015, in comparison with 2011. Although isolates of Acinetobacter spp. had lower resistance density in 2015 than in 2011 to the majority of investigated antibiotics, a statistically significant decrease was noted only for piperacillin/tazobactam. Statistically significant decreasing trends of consumption were recorded for third-generation cephalosporins, aminoglycosides and fluoroquinolones, whereas for the piperacillin/tazobactam, ampicillin/sulbactam and carbapenems, utilization trends were decreasing, but without statistical significance. In the same period, increasing trends of consumption were observed for tigecycline and colistin.

WHAT IS NEW AND CONCLUSION

Regular monitoring of resistance of bacterial isolates in ICUs and reporting of summary results to prescribers may lead to a significant decrease in utilization of some antibiotics and slow restoration of P. aeruginosa and Acinetobacter spp. susceptibility.

摘要

已知信息与研究目的

定期监测抗菌药物耐药性是针对重症监护病房（ICU）中引起医疗相关感染（HAIs）的细菌耐药问题的多方面干预措施的重要组成部分。我们的目的是分析在向处方医生强制报告耐药模式前后，引起HAIs的铜绿假单胞菌和不动杆菌属分离株的抗菌药物使用情况及耐药性。

方法

2011年1月至2015年12月期间，在塞尔维亚克拉古耶瓦茨临床中心的一个跨学科ICU进行了一项回顾性观察研究。干预措施包括对ICU患者的所有细菌分离株进行持续耐药性监测，并每半年向全院的处方医生报告每个分离株的结果。在ICU内跟踪了抗生素的使用情况以及铜绿假单胞菌和不动杆菌属耐药分离株的密度。

结果与讨论

与2011年相比，2015年铜绿假单胞菌对所有测试抗菌药物的耐药密度较低。虽然不动杆菌属分离株在2015年对大多数调查抗生素的耐药密度低于2011年，但仅哌拉西林/他唑巴坦的耐药密度有统计学显著下降。第三代头孢菌素、氨基糖苷类和氟喹诺酮类药物的使用量有统计学显著下降趋势，而哌拉西林/他唑巴坦、氨苄西林/舒巴坦和碳青霉烯类药物的使用趋势呈下降，但无统计学意义。同期，替加环素和黏菌素的使用量呈上升趋势。